FREE USMLE/COMLEX Question Bank | Question #19

[@DirtyMedicine]

To be perfectly clear, there are some comments asking about the phrasing “centrally acting dopamine blocker.” It may be more explicitly clear if I say cocaine is a centrally acting dopamine TRANSPORTER blocker. Cocaine inhibits the DAT (dopamine transporter) responsible for dopamine reuptake. The net effect of this dopamine blockade is to increase the availability of dopamine in the synapse. In either event, you should still get the question right based solely on hypertensive urgency.

[@DoctorVens]

Hey, Dirty! I just wanted to ask wouldn't cocaine's "dopamine blocking effect"(written in the question stem) also constrict the renal arteries which could cause ischemia and thus ATN -> Granular Cast?

[@DirtyMedicine]

That I know of, there are some case reports of atypical Cocaine induced interstitial nephritis and some instances of acute renal failure from cocaine use in renally compromised individuals, but this discussion is well beyond the scope of what you'd encounter on boards so I wouldn't worry about it. Furthermore the DA blocking effects of Cocaine tend to be centrally.

[@drgunjanchaudhary5689]

I was thinking the same 😅

[@drgunjanchaudhary5689]

But he said it’s RBC cast I said okay 😅

[@WhyNot-si4pj]

Cocaine is actually a pro dopamine substance ! Dopamine stimulates D1 receptors in the renal blood vessels resulting in renal vasodilatation ! Cocaine induced hypertension & tachycardia results from suppression of neuronal reuptake (reuptake I) of norepinephrine by adrenergic neurons ===>>> excessive sympathetic stimulation !

[@WhyNot-si4pj]

In a nut shell : Hypertensive urgency results in glomerular hemorrhage ===>>> RBC cast formation !

[@ismartshankar2823]

Can you make video on how to use UWORLD effectively and annotate?

[@chaditabaja1316]

Hey Dirty, if you question had said : patient was overdosed with a drug that antagonize dopamine receptors, and also stated history of psychiatric disorder, we would have though about NMS?==>rhabdomyolysis and ATN ==> Granular muddy cast?

[@blapspblamaster]

Question stem describes an incorrect MOA of cocaine which you've resolved in the comments. Was confusing! But glad you addressed this mistake in the comments. Yes, cocaine is a DAT blocker, but NOT a dopamine blocker.

[@dahuo8241]

Very Useful!Thank U sir!👍

[@HT.100]

The main man is back with another video

[@happsingh477]

question : by virtue of vasoconstriction caused by cocaine, can we not / should we not infer less volume going to the kidney, thereby ATN ?

[@M.Sajid98]

great thinking but the question here states that the drug that patient took acts *centrally*

[@farazsaleem3417]

Thank you for wonderful insight! But i want to ask why cant we think about focal segmental glomeruloseclerosis as in associated with cocaine and moreover as its a type of nephrotic syn so we should see fatty cast ! What do u think sir !

[@sleepytraveler369]

I thought the same, but then remembered that FSGS is a nephrotic syndrome and you wouldn't see RBCs

[@FareedKhan-dn9ce]

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[@vitaminbrit1]

Another great video! Thank you

[@sertactunc8759]

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[@Knstar5566]

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[@youme510]

Please please do more videos in this series They are very helpful and they are the best of your channel Don’t be late Thank you🌹

[@hassinayazid99]

So helpful. May god bless you!

[@rekhakadam6393]

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[@phillipwalter8993]

Comment done

[@nancelleloka4572]

Thank you so much

[@Shashankofficial24]

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[@maryc5905]

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[@xaaboopinkly]

Thanks sir! ❤️

[@yasir3299]

Nice.. Thx ur bro

[@champion8912]

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[@puneetgill4994]

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[@younottube9802]

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[@samimahmed41]

why is it not playing?

[@rajvigoradia4163]

@@samimahmed41 it's a premiere. it will play at 9:30